ORCID Profile
0000-0002-8781-6031
Current Organisation
University of Adelaide
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Publisher: Elsevier BV
Date: 2012
Publisher: SAGE Publications
Date: 03-2005
Publisher: SAGE Publications
Date: 28-12-2021
DOI: 10.1177/00048674211067720
Abstract: To examine trends in prescribing psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. A retrospective cohort study examined prescriptions written by general practitioners using MedicineInsight, a large Australian primary care database, covering approximately 9% of all general practitioner practices. Numbers of patients receiving prescriptions for five main classes of psychotropics (antipsychotics, antidepressants, attention deficit hyperactivity disorder medications, anxiolytics, and hypnotics/sedatives [including benzodiazepines and Z-drugs, but excluding melatonin]) were examined annually by age-group (0–4, 5–9, 10–14, 15–18 years). Melatonin was analysed separately. The number of patients prescribed any psychotropic increased from 25.6 to 36.2 per 1000 in iduals from 2011 to 2018 (average annual increase +4.5%, 95% confidence interval [4.1%, 4.9%] overall +41.4%). Among the five main classes, the largest annual increase was for attention deficit hyperactivity disorder medications (+9.6%, 95% confidence interval [8.8%, 10.5%] overall +95.8%), followed by antipsychotics (+6.2%, 95% confidence interval [5.0%, 7.3%] overall +62.8%) and antidepressants (+4.5%, 95% confidence interval [4.0%, 5.0%] overall +42.8%). Hypnotic/sedative prescribing decreased on average 6.5% per year (95% confidence interval [–8.0%, –5.0%] overall −40.2%). Anxiolytic prescribing remained steady. Melatonin prescriptions showed the highest increase of all (+24.7%, 95% confidence interval [23.7%, 25.8%] overall +606.7%). The largest annual increase in antipsychotic, antidepressant or attention deficit hyperactivity disorder medication prescribing occurred in 10- to 14-year-olds (+7.5%, +6.5% and +10.4%, respectively). The largest point prevalence occurred in 2018 among 15- to 18-year-olds, with 98.5 per 1000 prescribed antidepressants. Antidepressants were more frequently prescribed to females antipsychotics, attention deficit hyperactivity disorder medications and melatonin more often to males. The most prescribed antipsychotics were risperidone ( years) and quetiapine (15- to 18-year-olds). Fluoxetine was the most prescribed antidepressant in those aged 5+ years and amitriptyline in 0- to 4-year-olds. General practitioner prescribing of melatonin, antipsychotics, antidepressants and attention deficit hyperactivity disorder medications to under-19-year-olds increased markedly from 2011 to 2018. Although benzodiazepine and Z-drug prescriptions declined, this was offset by a substantial increase in melatonin prescribing.
Publisher: BMJ
Date: 21-02-2012
DOI: 10.1136/BMJ.E1242
Publisher: Royal College of Psychiatrists
Date: 03-2011
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/PY13032
Abstract: Many Australians have limited access to health-care services due to a range of barriers, including geographic distance and restricted mobility, which telehealth can potentially address. This paper reviews the current and potential use of video consultation in primary health care in Australia, drawing on international literature. There is substantial evidence of high patient satisfaction, but many studies have methodological limitations. Overall, evidence of effectiveness and cost-effectiveness is weak. There is reasonable evidence for diagnosis, home care and specialist consultations by GPs with patients present. Two telehealth initiatives using video consultation are briefly presented. Both provide evidence that video consultation has a valuable role to play, but does not obviate the need for face-to-face consultations. Video consultation challenges traditional professional roles, particularly those of nurses, and can improve health workers’ skills and job satisfaction. More fundamentally, telehealth challenges the traditional distinction between primary and secondary care. This can be a source of resistance but may ultimately be one of its strengths. Appropriately targeted video consultation has much potential to improve the delivery of primary health care in Australia, particularly in rural and remote regions.
Publisher: SAGE Publications
Date: 28-06-2013
Publisher: American Medical Association (AMA)
Date: 11-2015
Publisher: BMJ
Date: 16-09-2015
DOI: 10.1136/BMJ.H4320
Abstract: To reanalyse SmithKline Beecham's Study 329 (published by Keller and colleagues in 2001), the primary objective of which was to compare the efficacy and safety of paroxetine and imipramine with placebo in the treatment of adolescents with unipolar major depression. The reanalysis under the restoring invisible and abandoned trials (RIAT) initiative was done to see whether access to and reanalysis of a full dataset from a randomised controlled trial would have clinically relevant implications for evidence based medicine. Double blind randomised placebo controlled trial. 12 North American academic psychiatry centres, from 20 April 1994 to 15 February 1998. 275 adolescents with major depression of at least eight weeks in duration. Exclusion criteria included a range of comorbid psychiatric and medical disorders and suicidality. Participants were randomised to eight weeks double blind treatment with paroxetine (20-40 mg), imipramine (200-300 mg), or placebo. The prespecified primary efficacy variables were change from baseline to the end of the eight week acute treatment phase in total Hamilton depression scale (HAM-D) score and the proportion of responders (HAM-D score ≤8 or ≥50% reduction in baseline HAM-D) at acute endpoint. Prespecified secondary outcomes were changes from baseline to endpoint in depression items in K-SADS-L, clinical global impression, autonomous functioning checklist, self-perception profile, and sickness impact scale predictors of response and number of patients who relapse during the maintenance phase. Adverse experiences were to be compared primarily by using descriptive statistics. No coding dictionary was prespecified. The efficacy of paroxetine and imipramine was not statistically or clinically significantly different from placebo for any prespecified primary or secondary efficacy outcome. HAM-D scores decreased by 10.7 (least squares mean) (95% confidence interval 9.1 to 12.3), 9.0 (7.4 to 10.5), and 9.1 (7.5 to 10.7) points, respectively, for the paroxetine, imipramine and placebo groups (P=0.20). There were clinically significant increases in harms, including suicidal ideation and behaviour and other serious adverse events in the paroxetine group and cardiovascular problems in the imipramine group. Neither paroxetine nor high dose imipramine showed efficacy for major depression in adolescents, and there was an increase in harms with both drugs. Access to primary data from trials has important implications for both clinical practice and research, including that published conclusions about efficacy and safety should not be read as authoritative. The reanalysis of Study 329 illustrates the necessity of making primary trial data and protocols available to increase the rigour of the evidence base.
Publisher: Wiley
Date: 14-05-2023
DOI: 10.5694/MJA2.51948
Abstract: To determine longitudinal patterns of dispensing of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic/sedative medications to children and adolescents in Australia during 2013–2021. Retrospective cohort study analysis of 10% random s le of Pharmaceutical Benefits Scheme (PBS) dispensing data. People aged 18 years or younger dispensed PBS‐subsidised psychotropic medications in Australia, 2013–2021. Population prevalence of dispensing of psychotropic medications to children and adolescents, by psychotropic class, gender, and age group (0–6, 7–12, 13–18 years). The overall prevalence of psychotropic dispensing to children and adolescents was 33.8 per 1000 boys and 25.2 per 1000 girls in 2013, and 60.0 per 1000 boys and 48.3 per 1000 girls in 2021. The prevalence of psychotropic polypharmacy was 5.4 per 1000 boys and 3.7 per 1000 girls in 2013, and 10.4 per 1000 boys and 8.3 per 1000 girls in 2021. Prevalent dispensing during 2021 was highest for psychostimulants (boys, 44.0 per 1000 girls, 17.4 per 1000) and antidepressants (boys, 20.4 per 1000 girls, 33.8 per 1000). During 2021, the prevalence of dispensing was higher than predicted by extrapolation of 2013–2019 data for many classes, including antidepressants (boys: +6.1% 95% CI, 1.1–11.1% girls: +22.2% 95% CI, 17.4–26.9%), and psychostimulants (boys: +14.5% 95% CI, 8.0–21.1% girls: +27.7% 95% CI, 18.9–36.6%). The increases were greatest for girls aged 13–18 years (antidepressants: +20.3% 95% CI, 16.9–23.7% psychostimulants: +39.0% 95% CI, 27.9–50.0%). The prevalence of both psychotropic dispensing and psychotropic polypharmacy for children and adolescents were twice as high in 2021 as in 2013. The reasons and appropriateness of the marked increases in psychotropic dispensing during the COVID‐19 pandemic, particularly to adolescent girls, should be investigated.
Publisher: BMJ
Date: 12-05-2005
Publisher: Springer Science and Business Media LLC
Date: 2008
Publisher: Royal College of Psychiatrists
Date: 06-2010
DOI: 10.1192/BJP.BP.109.076166
Abstract: Numerous ecological studies have shown an inverse association between antidepressant use and suicide rates and a smaller number of in idual-based studies have shown an association between current antidepressant use and reduced suicide risk. Such evidence is often cited in support of the notion that antidepressants prevent suicide. However, more recently, the premises underlying this proposition, namely that suicide is caused by depression and that antidepressants relieve depression, have been challenged and the potential harm caused by antidepressants has been highlighted. In this article, Goran Isacsson and Charles Rich debate with Jon Jureidini and Melissa Raven the motion that the increased use of antidepressants has contributed to the worldwide reduction in suicide rates.
Publisher: BMJ
Date: 14-10-2015
DOI: 10.1136/BMJ.H5412
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2012
DOI: 10.1097/NMD.0B013E318257C6C7
Abstract: The descriptive diagnostic model since DSM-III has often led to "cookbook" diagnosis and assumptions of "chemical imbalance" for psychiatric disorders. Pharmaceutical companies have exploited this in their marketing. This includes promoting self-diagnosis with online checklists. Significant overprescribing of psychotropics has resulted. DSM-5 will provide new disorders and broader diagnostic criteria that will likely exacerbate this. Most psychotropic prescribing is done by primary care physicians, who are problematically excluded from DSM-5 field trials and are influenced by industry funded key opinion leaders who may promote diagnosis of subthreshold cases. More lax criteria will increase diagnosis of subthreshold cases. Expansion of not otherwise specified (NOS) categories can be used to justify off-label promotion. Pediatric bipolar disorder, constructed within the bipolar disorder NOS category, became an "epidemic" in the United States, fuelled by diagnostic upcoding pressures. Disruptive mood dysregulation disorder may similarly cause overdiagnosis and excessive prescribing, as will other new disorders and lower diagnostic thresholds.
Publisher: BMJ
Date: 11-05-2006
Publisher: SAGE Publications
Date: 28-06-2013
Publisher: SAGE Publications
Date: 2012
Publisher: Wiley
Date: 03-09-2016
DOI: 10.1111/AJR.12236
Abstract: Grey nomads - older people driving long distances recreationally and staying in caravans, tents or motor homes - are common on Australian highways. Although grey nomads report many benefits from their travels, there is anecdotal evidence that they impose a significant burden on rural/remote health services, including general practitioners, pharmacists and hospitals. There have been calls for better resourcing and service provision, but little reference to solid evidence on which to base this. This literature review is the first to integrate existing evidence for a health audience. Australia. Narrative literature search and synthesis. There is very little published information about the health and health service utilisation of grey nomads, and almost none in the medical literature. One key exception, a survey at a caravan park in the Kimberley region, found that, like other older Australians, many grey nomads have chronic diseases, and they have high rates of medication use. However, other studies have found that they generally view themselves as relatively healthy. There is some evidence of inadequate preparation for travelling. Issues include lack of health summaries, inadequate medication supplies and suboptimal vaccination. Some experience emergencies, sometimes resulting in hospital admissions. Overall, they place a poorly documented burden on rural/remote services. There is a need for further research on the health of grey nomads, their use of self-care strategies, and their uptake of health services both on the road and at home, to inform the provision of health services and optimise their well-being and health care utilisation.
Publisher: SAGE Publications
Date: 10-2012
No related grants have been discovered for Melissa Raven.